Cervical incompetence/insufficiency occurs in 0.1 to 1% of all pregnancies, and, traditionally, management involves transvaginal cervical cerclage. In some situations, however, such as in extremely short cervix following cone biopsy, congenital absent cervix, and in cases where transvaginal cerclage fails or is technically impossible, transabdominal approach via laparotomy is usually done. Recent data suggest that these methods should be reviewed in light of the advantages seen in the developments of minimal access surgical techniques. This article, therefore, compares both approaches (conventional and laparoscopy) and, in particular, discusses the use of laparoscopy in the management of cervical incompetence/ insufficiency both in pregnant and nonpregnant uterus.